Postmenopausal hormone replacement therapy and the primary prevention of cardiovascular disease

Area of Science:

• Cardiovascular Medicine
• Endocrinology
• Preventive Medicine

Background:

• Hormone replacement therapy (HRT) has been investigated for its potential role in preventing cardiovascular disease (CVD).
• Previous studies have yielded conflicting results regarding the efficacy of HRT in primary prevention of CVD and coronary artery disease (CAD).

Purpose of the Study:

• To evaluate the effectiveness of hormone replacement therapy (HRT) in the primary prevention of cardiovascular disease (CVD) and coronary artery disease (CAD).

Main Methods:

• A comprehensive literature search of MEDLINE and Cochrane databases was conducted for primary prevention studies on HRT, CVD, and CAD.
• Studies were reviewed, abstracted, and quality-rated using U.S. Preventive Services Task Force (USPSTF) criteria.
• Meta-analysis was performed on good or fair quality studies, with further analysis adjusting for potential confounding factors.

Main Results:

• The summary relative risk for CVD mortality with HRT was 0.75 (95% CrI, 0.42-1.23) and for CAD mortality was 0.74 (95% CrI, 0.36-1.45).
• Summary relative risk for CVD incidence was 1.28 (95% CrI, 0.86-2.00) and for CAD incidence was 0.87 (95% CrI, 0.62-1.21).
• Adjusted analyses indicated no significant benefit of HRT for CAD incidence, suggesting confounding by socioeconomic status, alcohol consumption, and exercise.

Conclusions:

• This meta-analysis suggests that HRT does not provide a benefit in the primary prevention of CVD or CAD.
• Findings align with recent randomized trials indicating no protective effect of HRT on CVD events.
• Randomized, controlled trials are essential to definitively determine the role of HRT in primary CVD prevention.